Clinical psychology postdoctoral fellowship program
ASSIGNMENT SUPERVISORS: Anjuli Amin, Ph.D.; Ariel Laudermith, Ph.D
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- ROTATION TRAINING GOALS
- ROTATION TRAINING OBJECTIVES: The Fellow will develop and solidify core competencies in the following domains (adapted from Robinson Reiter, 2007): 1. Clinical practice
- 3. Consultation and team performance
- Documentation/administrative skills
- Knowledge in the following domains
- TRACK 2 : FOCUS ON PRIMARY-CARE MENTAL HEALTH INTEGRATION
- ACTIVITIES IN CONSULTATION, ASSESSMENT, AND INTERVENTION
- ACTIVITIES IN SUPERVISION
ASSIGNMENT SUPERVISORS: Anjuli Amin, Ph.D.; Ariel Laudermith, Ph.D.; Irena Persky, Ph.D. ASSIGNMENT LOCATION: Home Based Primary Care (HBPC), a special population Patient Aligned Care Team Building 1/Building 228; Community (patients' homes & assisted living centers); Inpatient follow-up, when appropriate ROTATION DESCRIPTION: On this rotation, the Fellow will gain experience working as a member of an interdisciplinary Home Based Primary Care (HBPC) Program. HBPC is designated as a specialty PACT (Patient Aligned Care Team) population program, which is comprised of the following disciplines: medicine, nursing, pharmacy, kinesiotherapy, dietetics, social work, psychology, and psychiatry. The program provides a comprehensive array of services to Veterans with complex, chronic, and disabling medical diseases (e.g., heart disease, diabetes, cancer, stroke, dementia, motor neuron diseases such as ALS, etc), who often present with co-morbid mental and behavioral health conditions. HBPC services focus on supporting the effective management of chronic illness and reducing healthcare costs by empowering Veterans and their families/caregivers to maintain/restore health, maximize functioning and foster optimal quality of life. The overwhelming majority of patients in the program are geriatric, but ages vary widely (25-100). Hines HBPC program is one of the largest in the country, with four psychologists, one psychiatrist, and five social work staff, all of whom are integral members of the treatment team. Psychology services in HBPC are driven by Interdisciplinary Care, Collaborative Care and Patient Centered Care principles. HBPC Psychologists engage in these practices through ongoing collaboration with various team members. As part of patient care, the Fellow will be expected to provide ongoing team consultation services through activities such as participation in interdisciplinary team meetings, "curbside consultation," and making joint home visits with professionals from other disciplines. The Fellow will also promote communication/interactions between interdisciplinary team members and patients and their families to facilitate the treatment process. The Fellow will provide a full range of mental and behavioral health services that include biopsychosocial, cognitive, and capacity assessments, psychotherapeutic and behavioral medicine/rehabilitative interventions, and prevention-oriented services. Assessment and interventions will be provided through different modalities, such as direct in-person encounters and through telephone or telehealth mediums. The Fellow will have the opportunity to address Axis I conditions as well as subclinical symptoms of dysphoria and anxiety, and adjustment difficulties (e.g., adjustment to chronic or terminal illness, end-of-life issues). In addition, the Fellow will provide behavioral medicine interventions to manage pain, optimize rehabilitative gains, address sleep difficulties, promote weight loss and smoking cessation, enhance medical adherence and manage maladaptive behaviors. Psychological services will utilize evidenced-based and best-practice approaches focusing on integrated, patient-centric models of care (e.g., brief, time-limited). The Fellow will provide psychoeducational and supportive interventions for caregivers (i.e., spouses, family members) who are crucial to sustaining the Veteran in the home environment, managing their chronic illnesses, and preserving dignity at the end-of-life. For example, caregivers may be trained to better manage behavioral problems associated with dementia allowing for a reduction in the use of psychotropic medication as a means of controlling behavioral problems. Individual, couples, family and group interventions will also be provided across a variety of settings, including patients' homes (in both urban and rural communities), assisted living residences, outpatient hospital clinics, and inpatient hospital units (for continuity of care needs). This rotation emphasizes learning how to practice in the context of family and community and integrate the patient’s ecology into patient care. In general, only 25%-35% of clinical services are provided by the Fellow in patients' homes. In order to maximize learning opportunities, driving time is minimized as much as possible. When joint home visits are conducted driving time will be utilized for consultation or supervision purposes. The Fellow will also be encouraged to attend and present information at didactic seminars across disciplines (e.g., Geriatrics, Psychiatry, Primary Care), develop programming and participate in performance improvement projects. Opportunity to gain rural primary care experience is available through Hines' satellite clinics. The Fellow will have the opportunity to select a minor rotation (approximately six hrs/week), which could include: Tele-health Care Within this minor rotation, fellows will have the opportunity to co-lead short-term telephone groups for patients and/or caregivers. Examples of possible telephone groups include (but are not limited to): reminiscence therapy to reduce loneliness/depression, psychoeducation and coping (e.g., chronic heart failure management), and caregiver support. Fellows will have the opportunity to recruit patients, design the structure of the group, complete in-person pre and post group assessments, and co-lead weekly group calls. Rural Care HBPC Hines Psychologists cover five CBOCs (Community Based Outpatient Clinics), two of which are designated as rural by the Office of Rural Health. Fellows who elect this minor will have the opportunity to gain experience working with veterans and the interdisciplinary treatment team located in our rural areas. Fellows will gain insight into the unique characteristics and challenges (e.g., limited resources) of working within rural regions. Late Life Care Fellows who elect this minor will have the opportunity to work with patients who are nearing the end or their lives, some of whom may be diagnosed with a terminal illness. End-of-life choices and medical decisions have complex psychosocial components, ramifications, and consequences that have a significant impact on suffering and the quality of the living and dying. As people approach the end of their lives, they and their families commonly face tasks and decisions that include a broad array of choices ranging from simple to complex. Fellows will have the opportunity to assist patients as they face some of these issues, many of which may be practical, psychosocial, spiritual, medical or legal in nature. Caregiver/Family health A caregiver is someone (e.g., a spouse, adult child, parent, family member, or a friend) who provides personal care services for a Veteran. These services could include assistance with activities of daily living like personal hygiene, or providing supervision to ensure the safety of the Veteran. Within HBPC, psychologists play an integral role in supporting caregivers of Veterans, our partners in ensuring the best care of Veterans. Within this minor rotation, fellows will have the opportunity to provide evidence-based interventions for caregiver stress that focus on increasing caregivers’ knowledge of effective and safe caregiving strategies and improve their emotional coping skills in order to reduce or prevent stress-related problems and enhance their quality of life. Cognitive Assessment/Intervention Within HBPC, assessment opportunities include neuropsychological testing for patients who present with cognitive deficits and capacity and safety evaluations. Fellows who elect this minor will focus on enhancing their ability to select appropriate assessment tools and evaluate and communicate the results of testing to the patient and HBPC treatment team. Fellows will also work to familiarize themselves with the process of conducting testing within a patient’s home environment. Program Development and Evaluation/Administration Fellows who elect this minor rotation will have the opportunity to do a project within HBPC to meet the Fellowship Core Competency in Program Development and Evaluation/Administration. Some examples of completed projects include development and implementation of telephone education and therapy groups, patient tracking database development, and data analysis of referrals to HBPC Psychology. ROTATION TRAINING GOALS:
ROTATION TRAINING OBJECTIVES: The Fellow will develop and solidify core competencies in the following domains (adapted from Robinson & Reiter, 2007): 1. Clinical practice
2. Practice management
3. Consultation and team performance
For Fellows with an interest in Geropsychology, the nature of the HBPC population also allows for fulfillment of training objectives specific to and based on the Pikes Peak Model for Geropsychology Training (Knight, Karel, Hinrichsen, Qualls, and Duffy, 2008):
SUPERVISION: Following a graduated levels of responsibility model, the Fellow will initially shadow the supervising psychologist on home visits, then be accompanied by the supervising psychologist with fellow taking the lead during encounters, and subsequently transition to making home visits on his/her own. The Fellow will have a VA issued cell phone while in the community and a supervisor will be reachable via phone at all times while the Fellow is off-site conducting home visits. The Fellow will meet weekly with the supervising psychologist regarding core competencies and overall professional development. A major focus of supervision will be on evidence-based practice in psychology and professional development. Supervision will also encompass a didactic component, focusing on literature relevant to practicing in primary care settings, with a geriatric population, and in the community. TRACK 2: FOCUS ON PRIMARY-CARE MENTAL HEALTH INTEGRATION (i.e., nine month rotation in PC-MHI and three month rotation in HBPC) SUPERVISORS: Matthew Davis, Ph.D., M.P.H.; Julie Horn, Ph.D.; Jamie Mathews, Psy.D.; Kelly Moore, Ph.D. (licensure anticipated); Erin Zerth, Ph.D. LOCATION: Primary Care Clinics (Patient Aligned Care Teams or "PACT") and Specialty Medicine Clinics DESCRIPTION: On this rotation, the Fellow will work as a fully-incorporated member of an interdisciplinary Primary Care-Mental Health Integration (PC-MHI) team. At Hines VA Hospital, the PC-MHI team is referred to as Primary Care Behavioral Health (PCBH), in order to emphasize the collaboration with medical providers and limit stigma for Veterans receiving services. PCBH Psychology provides co-located, collaborative, biopsychosocially-oriented consultation, assessment, and intervention services within Primary Care's "Patient Aligned Care Team" (PACT) and select specialty medicine clinics. PCBH Psychology plays an integral role within the interdisciplinary PCBH team (comprised of psychology, psychiatry, social work, advanced practice nursing) and Primary Care service (comprised of physicians, medical residents, nursing, nurse practitioners, pharmacy, dietetics, education service, and medical social work) in assisting primary care providers with early identification and intervention of maladaptive health behaviors and mental health difficulties. PCBH Psychology provides same-day, open access behavioral medicine services via consultation with primary care providers as well as targeted evaluation and brief treatment for patients with broad-ranging clinical presentations such as anxiety and mood spectrum disorders, substance misuse, chronic illness, chronic pain, adjustment disorders, bereavement, attaining and maintaining healthy lifestyles, and somatic concerns. The Hines VA Hospital Primary Care general clinic patient population is primarily male, over age 50, and ethnically diverse; however, PCBH Psychology also provides services to Primary Care's distinct Women's Health and OIF/OEF clinics. ACTIVITIES IN CONSULTATION, ASSESSMENT, AND INTERVENTION: The Fellow will gain experience within a fast-paced and primarily-outpatient primary care setting. Broadly, the Fellow will focus on developing proficiency in health consultation, assessment and interventions that are respectful of the complexities and interactions of the biopsychosocial model of health. The role of PCBH Psychologists in Hines VA Hospital’s Primary Care Clinic is truly integrative, and Fellows will work collaboratively with Primary Care providers to enhance treatment of the full spectrum of medical and psychological problems that are presented by clinic patients. There will be an emphasis on both patient-centered consultation and cross-disciplinary collaboration. Interdisciplinary interaction takes place via participation in PCBH team meetings, Primary Care "teamlet" huddles, and curbside and formal consultation. The Fellow will be provided with medical knowledge sufficient to communicate with physicians and other Primary Care providers and to understand medical charts as well as the relationship between health and behavior. The Fellow will focus on developing assessment skills with specific patient concerns (e.g., insomnia, patient adherence associated with diabetes, cardiac issues, depression), as well as brief, targeted assessment focused on rapid problem identification and treatment planning. Assessment skills are also geared toward understanding how personality, psychopathology, and cognitive impairment can impact one’s ability to optimally participate in health care. The Fellow will have the opportunity to learn how medical illness may complicate the psychological diagnostic process as well as how psychological and behavioral health problems negatively impact one’s ability to optimally participate in maintaining their physical wellbeing. Intervention is typically focused on helping patients cope more effectively with major medical illnesses, promoting healthy lifestyles, encouraging treatment adherence, enhancing overall quality of life, and helping patients adjust to functional changes and shifts in family roles/dynamics that may occur as a result of medical problems. The majority of interventions are short-term, solution-focused, and cognitive-behavioral in nature. There is emphasis on using empirically-validated or evidence-based treatments for a spectrum of disease processes. ACTIVITIES IN SUPERVISION: The fellow will gain competence in provision of supervision to Psychology Interns and/or Externs. Level of supervisory responsibility will be dependent on the skill set of the incoming Fellow and will likely evolve through the training year. STRUCTURE: Over the course of the training year, the Fellow is expected to complete an nine-month major rotation within the PCBH program. This allows for immersion in clinical, administrative, and educational functions within clinic-based PCBH. In order to complement the development of integrated care competencies, the Fellow will spend the final three months of the training year in a major rotation within the Home Based Primary Care (HBPC) program. The Fellow will be encouraged to attend relevant didactic opportunities available throughout Hines VA Hospital; the affiliated Loyola University Medical Center; or other area grand rounds, seminars, and workshops, as available. The Fellow may also choose to complete a year-long minor rotation that will comprise six hours/week in PCBH, HBPC, or Health Promotion/Disease Prevention (HPDP) programming. Whereas all described minor rotation opportunities may be open to the Fellow to gain breadth of experience throughout the training year, selecting an area as a minor ensures depth in that particular area. Minors are determined in collaboration with staff and trainees at the beginning of the training year and are based on training needs as well as staff and clinic availability. Supervisors can offer an exhaustive list of potential minors at the beginning of the training year; however, examples of previous/potential minors are listed below: Health Promotion/Disease Prevention (HPDP) Health Promotion/Disease Prevention (HPDP) is a VA initiative launched in recognition that maladaptive health behaviors affect the development and maintenance of chronic disease. This assignment incorporates a strong behavioral medicine focus and emphasizes the unique health psychology skill set involved in the provision of both individualized patient-centered care and population-focused care to support Veterans in making positive health behavior changes. On this minor rotation, the Fellow will collaborate with the facility's Health Behavior Coordinators (HBC) in the provision of direct clinical care (individual and group), staff education, patient consultation, outreach, and program development/management/evaluation services consistent with health promotion and disease prevention initiatives. Health Promotion/Disease Prevention Services are interdisciplinary in nature, and highly integrated within Primary Care's Patient Aligned Care Team (PACT) and other medical center programs. Motivational Interviewing (MI)/Health Coaching Motivational Interviewing (MI) is an empirically validated treatment for a variety of psychological and behavioral concerns. Health coaching is an empirically-validated skill set to assist Veterans with making behavioral changes to improve their health. This assignment emphasizes increasing competency in provision and teaching of MI and health coaching. Postdocs will work with MI trained-staff members to increase utilization and confidence in these Veteran-centered strategies. Facilitation of MI and health coaching training session for hospital providers will also be incorporated. Behavioral Medicine Group Treatment Group treatment is integral to the Primary Care Behavioral Health (PCBH) program in that it supports the population-based model of care by providing targeted intervention to a large representation of Primary Care and specialty clinic patients. Groups are structured following empirically-based treatment protocols and emphasize adjustment to illness and management of emotional difficulties secondary to medical problems. A range of groups focused on behavioral and mental health concerns are offered through the PCBH program, including Healthy Living With Diabetes, CBT for Chronic Pain, Moving Forward (Problem Solving Therapy), Depression Related to a Medical Condition, Anxiety Related to a Medical Condition, and Caregiver Support. Fellows will also be involved in shared medical appointments, which are interdisciplinary appointments in PACT focused on a particular medical condition, such as hypertension, dyslipidemia, or diabetes. This minor rotation emphasizes increasing competency in providing psychoeducation and facilitating groups for various presenting problems. Opportunities to develop and implement a new group may be incorporated. Fellows may also have opportunities to supervise and co-facilitate groups with Psychology Interns and/or Externs. Rural and Tele-Mental Health The VA is committed to providing comprehensive healthcare and mental health care to Veterans located in rural settings who either cannot come to the main hospital campus for frequent visits, or whose local Community Based Outpatient Clinic (CBOC) might not have on-site staff to provide more specialized services. To allow for added convenience while maintaining the integrity of service-delivery, Veterans can go to their nearest CBOC and receive additional services as needed via video conferencing technology (V-Tel) that allows for live interface with healthcare providers located in another treatment setting. This minor rotation will focus on increasing competency providing PCBH services to Veterans at rural CBOCs through utilization of V-Tel equipment. It will also focus on providing integrated care across clinics and allow the fellow to gain experience working with rural populations. Appointments are scheduled in advance, and consistent with in-person PCBH services; interventions are generally short-term and emphasize using empirically-validated or evidence-based treatments. Chronic Pain PCBH offers a stepped-care, population-focused approach to the behavioral health treatment of chronic pain for the entire hospital population. PCBH is instrumental in collaborating with other medical specialties to ensure coordination of care across treatment settings. Opportunities on this minor rotation include facilitating interdisciplinary “Coping with Chronic Pain” pain psychoeducation classes, evidence-based intervention groups, and focuses individual assessment and treatment. Weight Loss and Bariatrics PCBH staff partner with the VA’s MOVE! weight loss program to provide behavioral medicine-oriented treatment for Veterans seeking weight loss assistance. Opportunities include consultation on hospital policy, interdisciplinary collaboration, educational and group intervention, and individual assessment (e.g., bariatric pre-surgical evaluation, eating disorder assessment) and treatment. Directory: about about -> Request for Quotation (rfq) Number: doc52papt1000018 about -> Review of 2004 contents about -> Annual InStructional unit plan about -> Annual InStructional unit plan about -> Unit: Automotive and Auto Body about -> United Nations Children’s Fund (unicef) Phnom Penh, Cambodia Vacancy Nº cp/15/006 Terms of Reference Individual Consultancy: Monitoring about -> Response to a letter from a recovering addict’s wife with concerns about 12-step groups about -> Analysis of Law in the United Kingdom pertaining to Cross-Border Disaster Relief Prepared by: For the 30 June 2010 Foreword about -> About perkins compiled by about -> United states department of education Download 435.72 Kb. Share with your friends:
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